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  • Title: Maximizing immunization coverage through home visits: a controlled trial in an urban area of Ghana.
    Author: Brugha RF, Kevany JP.
    Journal: Bull World Health Organ; 1996; 74(5):517-24. PubMed ID: 9002332.
    Abstract:
    A strategy of home visits to maximize children's immunization coverage was implemented in three towns in Ghana. The strategy was tested in town 1 in a controlled trial where clusters of children were allocated to the intervention and control groups. A total of 200 mothers in the intervention group were visited at home by non-health workers and their children were referred to a routine under-fives' clinic. Subsequent home visits targeted at those who failed to complete immunization schedules were made by nurses. After 6 months, coverage had risen from 60% to 85%, which was 20% higher than in the town 1 control group of 219 age-matched children (P < 0.005). A similar home-visiting strategy in a neighbouring town resulted in a rise in coverage from 38% to 91% (n = 55), mainly through home immunizations. Children were more likely to complete the schedule if their fathers were interviewed and participated in the decision to send them to the clinic. Countries with national service programmes can use a home-visiting strategy to supplement and strengthen their routine immunization programmes. A wide range of other community-based primary health care interventions could also be tested and implemented using this methodology. The strategy of home visits to maximize children's immunization coverage was evaluated in three towns in Eastern Ghana in 1991-92. Mothers were visited by a non-health worker and referred to an under-fives clinic; if they failed to follow through, a second home visit was made by a nurse. After 6 months, the proportion of completed schedules was significantly higher among the 200 intervention group children than the 219 controls, whether measured by card only (85.5% vs. 62.6%) or by card and history (86.0% vs. 66.7%). Complete coverage was most likely when the mother followed the advice of the interviewer and, without further prompting, brought the child to the health clinic (relative risk (RR), 1.43; 95% confidence interval (CI), 1.17-1.75), when a nurse met the mother at a subsequent home visit (RR, 0.40; 95% CI, 1.00-1.96), and if fathers were interviewed and participated in the decision to send the child to the clinic (RR, 1.85; 95% CI, 1.10-3.12). During the home visit period, 70.2% of previously uncompleted immunization schedules were completed. Other potential advantages of home visits include disaggregated data collection, identification of pockets of low immunization coverage, information on health service users' perspectives, and the involvement of fathers in health care decision making. However, home visiting should be viewed as a means of strengthening routine primary health care service provision and not as a substitute for clinic services.
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